Pediatrics ACE Rounds Abd Pain

Tummy Trouble

100

hyperventilating. +thirst, AMS, K 5.7, serum Osm 324

Dx: DKA

200

weight loss, fatigue, diarrhea for “a while”. 99.9F, mucosal pallor, oral ulcer

Dx: Crohn's

300

nausea, diarrhea, low appetite. 99.7F, pain on passive ROM R leg

Dx: Appendicitis

_{(Psoas sign - passive extension of R thigh, LL decubitus)}

500

Hx undescended testes, SBP/DBP above nl, Hgb below nl, 3+ protein & RBCs in urine. Surgical pathology: glomeruli and tubules, stroma, and undifferentiated cells of metanephric origin

Nephroblastoma (Wilm’s tumor) _{a/w Denys-Drash syndrome (pt mutation in WT1 gene)}

Awful Abdomen

100

+fatigue, diarrhea x7d, petechiae, SOB, jaundice, decreased urination. Outbreak

Dx: HUS

200

+n/v, dysuria, 100.6F, cervical motion tenderness, Giemsa stain: cytoplasmic inclusions

Dx: PID 2/2 Chlamydia trachomatis

300

fussy, vomited x2, ND/NTTP. Imaging shows narrow space between radio-opacities

Foreign body ingestion _{(stacked magnets, pain out of proportion)}

400

+arthralgia, nausea, sibling and patient recently sick. Nonblanching coalescent urticaria on the legs

IgA vasculitis _{(and if they subsequently have sausage shaped mass, high pitched BS, currant jelly stool → intussusception)}

Advanced (acute) Placement (pancreatitis)

100

The pain a/w Pancreatitis is provoked / palliated how? Presents with pain localized where most commonly?

Worse after meals and supine position

Improved leaning forward

Epigastric pain

200

Name all 3 criteria to Dx pancreatitis

-characteristic abd pain

-lipase or amylase at least 3x ULN

-characteristic findings on cross-sectional imaging (1st line: U/S, then CT AP IVC)

300

You should consider AP on the DDx for infants and toddlers if they present with:

irritability and vomiting

400

Patient Dx'd w/ AP. Suggest a reasonable initial plan.

Pain ctrl: acetaminophen, tylenol prn pain

Fluids: LR or D5NS 1.5-2x mIVF w/in 24h admit (monitor BUN/Cr, UO for 24-48h)

Nutrition: PO w/in 24-48h admit (parenteral if not tolerating)

Misc 1

100

What is the most common, most serious cause of acute abdominal pain in a 1 month old?

NEC

200

True or false: in pediatric patients, pancreatic ducts > 2.2mm were more likely a/w AP

False, duct size threshold varies w/ age

_{>1.5mm (1-6y)}

_{>1.9mm (7-12y)}

_{>2.2mm (13-18y)}

300

Patient Dx'd w/ AP cannot tolerate PO. Next best step for #nutrition?

Enteral tube (NG or nasojejunal) feeds

400

IGETSMASHED is an acronym in context of AP. What does it stand for?

Idiopathic, Gallstones, EtOH, Trauma, Steroids, Mumps, Autoimmune, Scorpion poison, Hypercalcemia or hypertriglyceridemia, ERCP, Drugs

500

Which type of pancreatic cell is injured, leading to enzyme activation and ultimately AP?

Acinar cell

Misc 2

500

A study in 1970 reported that over a two-month period 30 patients were admitted to a hospital following stings of the scorpion, the Tityus trinitatis, in which country?

Trinidad (tech.  Republic of Trinidad and Tobago)